Healthcare Provider Details

I. General information

NPI: 1407001811
Provider Name (Legal Business Name): JOHN T. WILL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 PANTOPS MOUNTAIN PL STE 1
CHARLOTTESVILLE VA
22911-4662
US

IV. Provider business mailing address

211 SPRUCE ST
CHARLOTTESVILLE VA
22902-5940
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-1817
  • Fax:
Mailing address:
  • Phone: 931-212-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number9109
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number57656
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number040142934
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: